Our data show no significant increase in side effects or decrease in efficacy while cycling antibiotics among neutropenic patients and thus support further study of its role.

No abstract

The clinical effects of peripheral sympathectomy on patients with vaso-occlusive disease are often dramatic and include relief of pain, improved quality of life, and healing of ulcers. Peripheral periarterial sympathectomy is known to increase skin temperature and to maximize the nutritional component of peripheral blood flow, but the pathophysiology of vaso-occlusive disease and the physiologic mechanisms of this treatment are unknown. In this study, the acute effects of periarterial sympathectomy were directly observed in a rabbit ear model of digital microcirculation (arterioles, arteriovenous anastomoses, and venules). The effects of periarterial sympathectomy on cutaneous perfusion and total flow were also examined using laser Doppler perfusion imaging and digital temperature measurements. The central auricular artery became dilated (50-100%) immediately after sympathectomy; the arterioles, arteriovenous anastomoses, and venules dilated to 165, 156, and 223%, respectively, at 30 minutes and to 187, 174, and 204%, respectively, at 60 minutes, relative to their baseline diameters prior to sympathectomy. Laser Doppler perfusion imaging values and ear temperatures were noted to increase after sympathectomy (8.9%, 3 degrees C), although the core temperature of the rabbit did not change. Thus, acute periarterial sympathectomy can (a) effectively reduce the vascular tone of the distal microvasculature and (b) increase total microcirculatory perfusion-cutaneous and thermoregulatory-by both venular and arteriolar dilation. Periarterial sympathectomy has the clinical potential to increase nutritional blood flow, thereby ameliorating the signs and symptoms of ischemia associated with thermoregulatory abnormalities. Dilation of the arteriovenous anastomoses, with a subsequent reduction in vascular resistance, may contribute to the increased cutaneous temperature noted after sympathectomy.

Background: Many nonbiological variables PsychobiologyFellowship grant MH 18399 (Michael Irwin, M.D.), and are reported to predict treatment response for UCSD ClinicalResearchCentergrant M01 RR00827 (Edward W.Holmes, major depression; however, there is little agree-M.D.). merit about which variables are most predictive. A preliminary analysis of these data was presented at the Young Method: Inpatient subjects (N = 59) diagnosed Investigatorsposter session at the 151st annual meeting of the American with current DSM-IV major depressive disorder PsychiatricAssociation;May 30--June4, 1998; Toronto,Ontario, Canada. The authors thank Marla sinith, R_N.; Kathy Resovsky, R.N.; and completed weekly depressive symptom ratings Debbie Greenfield,M.A.,for assistance with data collection and Lesley with the Hamilton Rating Scale for Depression Wetherell,B.S.,for data-managementand statistical support.